Objective: To evaluate the long‑term anatomical and sexual outcomes of laparoscopic peritoneal colpopoiesis among women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.
Material and methods. We conducted a retrospective and observational single center study. Between January 2007 and May 2017, 16 patients with MRKH syndrome were treated with laparoscopic peritoneal colpopoiesis procedure.
Results. The mean age of patients at the time of diagnosis was 18.8 years, and that at the time of hospitalization was 20.6 years. Concomitant congenital anomalies, such as urinary tract anomaly, were reported in six (37.5%) patients, various malformations of the cardiovascular system were reported in two (12.5%) patients. Mean surgery duration was 122.6 minutes (range 65 – 295 min); mean intraoperative blood loss was 75.3 ml (range 30 – 200 ml). Anatomical success, along with the absence of stenosis and reduction of the tissue flap was achieved in 100% cases. According to the female sexual function index (FSFI), results show good quality of sexual life. One of the patients, thanks to transvaginal donation of oocytes and surrogate motherhood, is raising her own child at the age of 3 years.
Conclusion. Laparoscopic peritoneal colpopoiesis can be used as an effective and low-traumatic technique for creating a neovagina, taking into account the anatomical structure of the perineum. 5BULLETIN OF SURGERY IN KAZAKHSTAN №1 2023
Nasal defects are a common human pathology and are formed as a result of trauma, removal of neoplasms or congenital pathology. Elimination of a nose defect is a complex problem of reconstructive surgery. Historically, information about the restoration of the nose dates back to 3000 years BC. In the post-war years the F. M. Khitrov method (1) was widely used in the USSR, which has not lost its relevance at the present time. The advantage of the method is the possibility of harvesting a sufficient volume of tissues for both side, the outer cover and the inner lining and the creating conditions for forming the nose frame. The disadvantage of the method is multi-stage, the risk of violation of the trophic flap at the stages of treatment, inconsistency of texture and color to local tissues. The aim of the work is to improve methods for eliminating total nasal defects. On the example of one clinical case, a method for restoring the main anatomical structures of the nose is described. The use of autologous cartilage and a paramedian forehead flap is the optimal solution for the elimination of total nasal defects.
Keywords
facial plastic surgery, nasal defect, paramedian forehead flap, surgery planning
Among the complications of endovascular abdominal aortic aneurysm repair the most common are the so–called endoleaks - the preservation of blood flow inside an isolated aneurysmal sac. This complication occurs in almost every fourth patient and is the main cause of reinterventions, which makes the late development of this complication one of the urgent problems under discussions. The report presents a clinical case of treatment of a patient with an aneurysm of the infrarenal abdominal aorta with its spread to the common iliac artery using the technique of preventive embolization of the internal iliac artery with application of a liquid tantalum-containing ethylene vinyl alcohol copolymer. All stages of the operation were performed in the catheterization laboratory using a stationary angiographic system. The embolizing material was introduced after implantation of the stent-graft into the target position, through a microcatheter pre-installed at the ostium of the embolizing internal iliac artery. The introduction of a tantalum-containing ethylene vinyl alcohol copolymer after the installation of the stent-graft, under conditions of significant reduction of arterial antegrade blood flow in the lumen of the internal iliac artery, allowed to create a reliable occlusion of the ostium segment of the artery, reduced the risk of migration of embolizing substance into the distal arterial bed.
This literature review shows the essence of the problem of extracranial carotid artery stenosis, since this disease is a treatable cause of ischemic stroke and can be reliably detected and assessed by using vascular ultrasound. In Kazakhstan, due to acute disorders of cerebral circulation, 11.1 thousand patients die every year. The reliability of the information in the article was obtained by using the literature data of the last 10 years. The reflection of the criteria for diagnosing stenosis of the extracranial carotid artery, the use of which, in conjunction with standard tests and other sensitive methods, makes it possible to determine the lesion of the extracranial carotid artery at an early stage, as well as a detailed description of diagnostic methods of this complication and evaluation of their effectiveness. Screening for carotid stenosis is important, and whether routine carotid ultrasound is recommended in general population for the prevention of ischemic stroke remains controversial. Screening for carotid stenosis by ultrasound is crucial not only for the daily clinical setting, but also for the management of patients with acute ischemic stroke. 21BULLETIN OF SURGERY IN KAZAKHSTAN №1 2023
Keywords
Stenosis of the carotid artery, extracranial carotid artery, ischemic stroke, acute disorders of cerebral circulation, diagnosis of stenosis of the extracranial carotid artery
Objective: to determine the long-term postoperative outcomes of inguinal hernias using the TAPP approach with the internal ring suturing.
Materials and methods. The design is a randomized multicentre clinical study. The study is based on a survey of 268 patients aged 18 to 84 years (mean age 59.2±10.6 years), including 46 (17.2%) women, 222 (82.8%) men with primary inguinal hernias. A total of 187 (69.8%) patients had a normal body mass index, 72 (26.9%) were overweight, 9 (3.3%) were obese. Interventions supposed the open techniques (Liechtenstein technique - 118 patients or Shouldice technique - 29 patients) and laparoscopic technique by TAPP approach (total 121), and specifically the modification with the internal ring suturing (12). The frequency and severity of chronic postoperative pain (up to 1 year) and the recurrence rate of inguinal hernia (up to 2 years) had been determined.
Results. The incidence and severity of chronic pain syndrome was moderate and in most cases were found to have no any intergroup significant differences. Single case showed the significant differences in incidence between open hernioplasty by Liechtenstein technique and TAPP (χ2=4.241, p=0.040). The recurrence rate of hernias over the 2-year follow-up period was 3.0%. There were no significant differences whichever surgical method to be used. There was not any single case of relapse in the TAPP-IRS target group. The age of patients related to the most crucial risk factor; the intervention technique ranked number two. Account must be taken of the TAPP-IRS subgroup, where any recurrence not reported. The type of intervention had a minimal effect on the risk of recurrence, in particular due to interventions techniques restricted by open operations only. Conclusions. When performing open and laparoscopic hernioplasty for indirect inguinal hernia, the incidence and severity of postoperative pain after 1 month is lower with the laparoscopic method, and after 12 months it remits and has comparable characteristics. The TAPP-based internal ring suturing does not affect the postoperative pain syndrome. The recurrence rate of inguinal hernia after open and laparoscopic hernioplasty found to have no significant differences. When using TAPP-IRS, no relapses were reported. 27BULLETIN OF SURGERY IN KAZAKHSTAN №1 2023
Keywords
inguinal hernia, surgical treatment, TAPP, internal ring suturing Average long-term outcomes of laparoscopic inguinal hernia repair
The relevance of the problem is due to the continuous increase in morbidity and the lack of effectiveness of existing treatment methods. The aim of the study is to improve the treatment results of patients with autoimmune thyroiditis by introducing modern laser technology. The study was conducted retrospectively from 2008 to 2021 and is based on data from the examination and treatment of 481 patients with autoimmune thyroiditis. The patients were divided into groups according to the applied treatment methods: the first group - 129 (29,19%) patients, the second group - 106 (23,98%) patients, and the third group - 207 (46,83%) patients. The concentrations of thyroid hormones, pituitary gland and antibodies to thyroid tissues in the blood serum of patients before and after treatment were studied and compared. Long-term treatment results were studied in 340 (70,7%) patients (t=8,8, p≤0,001). Photodynamic therapy, in combination with sessions of intravenous laser blood irradiation with low-intensity laser radiation, contributed to the normalization of thyroid hormone levels (TSH, FT4 and FT3) of the thyroid gland on the 15th day of treatment. Combining conservative treatment of patients with autoimmune thyroiditis with photodynamic therapy allows to obtain good and satisfactory results in 77,5% of cases, which gives reason to recommend photodynamic therapy in combination with sessions of intravenous laser blood irradiation with low-intensity laser radiation as an effective way to complement traditional conservative treatment.
Keywords
autoimmune thyroiditis, antibodies to thyroid tissues, photodynamic therapy
Critical lower limb ischemia (CLI) is the final stage of peripheral arterial disease and occurs with chronic pain at rest, loss of tissue and limb. Despite the active development of new technologies, including endovascular and open surgical methods of treatment, and the development of various guidelines, CLI still remains an unresolved burden of vascular surgery around the world. The second part of the review describes large randomized trials, open and endovascular methods of lower limb revascularization in CLI. Also, the use of deep vein arterialization technology in No-option cases for conventional methods of revascularization. deep vein arterialization
Purpose. Our research explores the effect of the use of PRP therapy in accelerated recovery and wound healing after hemorrhoidectomy.
Material and methods. A study based on the results of the treatment of patients with chronic hemorrhoids who were treated from January 2021 to January 2022 was conducted based on the surgical department of the RDC and MIPO Clinics LLP. The study included 100 patients aged 21 to 72 years with chronic hemorrhoids of stage II and III, in the treatment of which the method of hemorrhoidectomy with PRP therapy (main group) and open hemorrhoidectomy (control group) was used. In the analysis of clinical efficacy, the severity and duration of pain syndrome, manifestations of complications in the early postoperative period, cytomorphological analysis of fingerprint smears, the number of bed days spent, and the period of recovery were used. An analysis of the assessment of the quality of life of patients after surgery in the long-term period was also carried out.
Results. The intensity of pain severity was estimated at an average of 3±0.2 points in the main group and 6.1±0.3 points in the control comparison group. The duration of pain continuation after surgery averaged 3.1±0.2 days in the main group and 4.4± 0.2 days in the control comparison group. The development of early postoperative complications in the main group – in 6 (12%), in the control group were diagnosed in 14 (28%) cases. When assessing the dynamics of the wound process according to the cytological picture, it was noted that the neutrophil reaction was more pronounced in the control group. In the main group, epithelization elements appeared faster (from the 10th day - in 35%). The average epithelialization time was 31.1±2.2 days in the control group compared to 20.3±3.9 days in the main group. In the main group, by day 15, 31 (62%) patients and by day 25, 50 (100.0%) all patients returned to work. In the control group, 32 (64%) patients started working by day 30 and 100% by day 40.
Conclusion. Taking into account the results of the study, the use of an integrated approach with the use of PRP therapy in the treatment of chronic hemorrhoids is recommended. It is shown that the use of the proposed patented treatment regimen leads to a decrease in postoperative pain syndrome, accelerated wound healing, and a decrease in the number of complications. 49BULLETIN OF SURGERY IN KAZAKHSTAN №1 2023
Primary biliary cholangitis (PBC, formerly known as primary biliary cirrhosis) is one of the most significant diseases that is predominantly verified in women. The prevalence of PBC is 1.9-40.2 per 100,000 population. Antimitochondrial antibodies (AMA) are of major importance for the diagnosis of primary biliary cirrhosis (PBC), and it has also been suggested that they may be involved in the pathogenesis of the disease. conflicts of interest
Objective: The aim of this study was to characterize the clinical, biochemical parameters and response to UDCA (Paris I criteria) PBC patients depending on AMA status in the Republic of Kazakhstan.
Material and methods. The study was conducted on the basis of the Research Institute of Cardiology and Internal Diseases from 2014 to 2019. A total of 212 patients with primary biliary cholangitis were recorded.
Results. Among 212 patients, 171 (80.7%) were AMA-positive and 41(19,3%) - AMA-negative. Vast majority of patients in both groups were Asian (179; 84.4%) and female (206; 97.2%). Severe disease (F3/4) was revealed in 108 (63.2%) AMA-positive and in 18 (43.9 %) AMA-negative patients (p>0.05). AMA-positive and AMA-negative PBC were associated with autoimmune hepatitis in 88 (51.5%) and 10 (24.4%) cases (p<0.01), rheumatoid arthritis in 26 (15.2%) and 5 (12.2%), autoimmune thyroiditis in 35 (20.5%) and 4 (9.8%), vitamin D deficiency in 89 (52.1%) and 19 (46.3%), osteoporosis in 48(28.1%) and 7 (17.1%), gallstone disease in 43 (25.4%) and 8 (21.2%) respectively (p >0.05). Response to ursodeoxycholic acid (UDCA) treatment according to Paris I criteria was noted in 24 out of 81 (29.6%) AMA-positive and in 9 out of 22 (40.9%) AMA-negative patients (p>0.05).
Conclusion. In patients with AMA-positive PBC compared with AMA-negative, there is a statistically significant high value of autoimmune hepatitis and autoimmune thyroiditis. Whereas, response to UDCA treatment according to Paris I criteria is higher in AMA-negative PBC.
The study aimed to create a Kazakh-language version of the P-QoL questionnaire based on relevant international requirements to determine its psychometric properties.
Materials and methods. The Kazakh-language version of the P-QoL questionnaire was tested to determine its reliability, validity and sensitivity. A total of 126 respondents participated in the study, of which 66 respondents with various stages of genital prolapse (the main group) and 60 respondents made up the control (asymptomatic) group. Spearman’s correlation analyzed the reliability of “test” and “retest”. The internal consistency between the questions was assessed based on the results of the calculation of the Kronbach-α coefficient. The threshold value > 0.7 is determined acceptable.
Results. The mean age was 56±6.01 years for the main group and 33±4.87 years for the control group. Cronbach’s α-coefficient exceeded 0.7 (range 0.77 – 0.97). The maximum significant correlations of reliability of “test” and “retest” (p < 0.001) were established.
Conclusion. Assessment of QoL in patients with POP is an important part of a comprehensive analysis of the effectiveness of the treatment. The results obtained using the validated Kazakh P-QoL questionnaire will allow obtaining a reliable analysis of the data, which will make it possible to individualize the treatment program taking into account the characteristics of the population.
Keywords
pelvic organ prolapse, quality of life, validation
